Digestive Diseases and Sciences最新文献

{"title":"Low Rates of Aborted Endoscopy Due to Gastric Food Retention in Patients on Glucagon-Like-Peptide-1 Receptor Agonists.","authors":"Bharati Dev, Yousaf Hadi, Anam Rizvi, Christopher Cao, Brian Horwich, Nicholas A Hoerter","doi":"10.1007/s10620-025-08915-1","DOIUrl":"10.1007/s10620-025-08915-1","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use has dramatically increased with expanded indications for weight loss. Delayed gastric emptying due to these medications can lead to residual food in the stomach, which can increase the risk of periprocedural aspiration during endoscopic procedures. The aim of this study is to document rates of gastric food retention and aspiration events during upper endoscopy in patients on GLP-1 RA.</p><p><strong>Methods: </strong>A retrospective cohort study was performed including all patients who underwent upper endoscopic procedures at two hospitals during 2018-2023. Procedure abortion due to the presence of food was taken as primary study endpoint. The secondary endpoint was aspiration events in patients with food noted on endoscopy.</p><p><strong>Results: </strong>Out of a total of 32,275 total upper endoscopic procedures performed during the study period, 1179 procedures were performed in patients taking GLP-1 RAs (GLP-1 cohort). In total, 37 endoscopies (0.1%) were aborted due to retained gastric food; 7 patients (0.6%) in the GLP-1 cohort vs 30 patients (0.096%) in the non GLP-1 cohort (p < 0.01). There were no episodes of aspiration in patients with retained food.</p><p><strong>Conclusions: </strong>In a large retrospective cohort, GLP-1 RA use did increase rates of gastric food retention during upper endoscopy, though the absolute risk was minimal. There were no aspiration events related to gastric food retention. Because of the small number of events, there were no clear modifiable risk factors for gastric food retention. This study supports the practice of individualized periprocedural management in patients on GLP-1 RA.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1838-1843"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Alcohol in Steatotic Liver Disease: Impact on Patients with Cardiometabolic Risk Factors.","authors":"Francisco Capinha, Sofia Carvalhana, Helena Cortez-Pinto","doi":"10.1007/s10620-025-08912-4","DOIUrl":"10.1007/s10620-025-08912-4","url":null,"abstract":"<p><p>The new definition of steatotic liver disease (SLD), as a broader concept, was a step forward in the increasing recognition of the substantial overlap between alcohol and cardiometabolic risk factors (CMRFs), in a continuum way. The spectrum of pathophysiological aspects, ranging from liver steatosis to fibrosis, has similarities in MASLD and ALD. Also, there is now considerable evidence that the association of metabolic dysfunction with increased alcohol consumption impacts on the risk of severe liver disease and prognosis. The new MetALD class, as recently proposed, shows clear differences in prognosis when comparing with MASLD and ALD groups. However, there is room for improvement, such as considering the role of previous alcohol intake, fluctuations of consumption over time, including binge drinking, refinement of alcohol assessment, and better understanding of the role of biomarkers. In summary, SLD is no doubt a significant improvement, but the new classification needs to be dynamic and adapting to patients needing frequent reassessment. Furthermore, it brings opportunities for research on the interaction between alcohol consumption and CMRFs.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1746-1756"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selenomethionine Alleviates Alcohol-Induced Liver Injury by Inhibiting Ferroptosis.","authors":"Feng Chen, Zhenhua Zhou, Jinxian Fu, Chang Gao","doi":"10.1007/s10620-025-08960-w","DOIUrl":"10.1007/s10620-025-08960-w","url":null,"abstract":"<p><strong>Background and aim: </strong>Selenomethionine (Se-Met) has been reported to reduce oxidative stress (OS) and hepatic injury; however, its role in alcoholic liver disease (ALD), particularly with ferroptosis, remains poorly understood.</p><p><strong>Methods: </strong>Oxidative stress was induced using ethanol, and ferroptosis was inhibited with ferrostatin-1 (fer-1) in L-02 and LX2 cell lines, respectively. The effects of Se-Met on alcohol-induced hepatocyte damage were evaluated in vitro by examining cell viability, lipid peroxidation, and the level of key ferroptosis-associated markers. In vivo, the interaction between Se-Met and ferroptosis was examined via an ALD mouse model through analyses of liver histology, lipid peroxidation, liver function, and ferroptosis-related indices.</p><p><strong>Results: </strong>In vitro and in vivo experiments indicated that both Se-Met and fer-1 have a significant protective role against alcohol-induced hepatocyte death and liver injury. Treatment with Se-Met or fer-1 can promote hepatocyte proliferation, ameliorate the typical symptoms of lipid peroxidation (e.g., glutathione depletion, superoxide dismutase enzyme activity, intracellular reactive oxygen species (ROS) level, malonaldehyde (MDA) content), and altered the expression of ferroptosis-related factors. Moreover, the findings indicated that the administration of Se-Met or fer-1 significantly ameliorated the pathological alterations and improved liver function indices associated with alcohol-induced liver damage in mice. These effects may collectively suppress the deleterious impact of ethanol on hepatic tissue.</p><p><strong>Conclusion: </strong>This study concluded that the ferroptosis pathway regulated alcohol-induced hepatocyte injury. The administration of selenomethionine protects ALD by partially inhibiting the ferroptosis pathway, providing a novel therapeutic approach for ALD.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1779-1787"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mirikizumab in the Treatment of Ulcerative Colitis: Initial Real-World Data in a Population from a Large Tertiary Center.","authors":"Joëlle St-Pierre, David Choi, Evan Fear, Natalie K Choi, Alex J Mathew, Russell D Cohen, Sushila R Dalal, Joel Pekow, Noa Krugliak Cleveland, David T Rubin","doi":"10.1007/s10620-025-08950-y","DOIUrl":"10.1007/s10620-025-08950-y","url":null,"abstract":"<p><strong>Background: </strong>Mirikizumab, an anti-p19IL-23 monoclonal antibody, has shown efficacy and safety in treating moderately to severely active ulcerative colitis (UC) in clinical trials. We assessed the effectiveness and safety of mirikizumab for the treatment of UC in a real-world setting.</p><p><strong>Methods: </strong>We conducted a prospective observational study of adult patients with UC who were started on mirikizumab for active disease between January 1, 2024, and April 30, 2024. Clinical, biochemical, sonographic, and endoscopic data were collected. The primary outcome was clinical response and remission at 12 weeks, and secondary outcomes included corticosteroid-free remission (CSFR) and biochemical marker improvement at week 12. Adverse events were recorded.</p><p><strong>Results: </strong>Twenty-two patients were initiated on mirikizumab during the study period, with 20 included in the analysis. The majority were female (65%) and had a median duration of disease of 12 years (IQR 8.0-18.5]. The majority of patients had previously been exposed to three or more advanced therapies (70% of patients) prior to mirikizumab start. Clinical remission (SCCAI < 3) increased from 30% at baseline to 83% at week 12. CSFR increased from 15% at baseline to 78% at week 12. Median SCCAI scores significantly decreased from 3.5 at baseline to 0.5 at week 12 (p < 0.001), driven primarily by an improvement in general well-being and a decrease in urgency. Adverse effects were mild to moderate, with one serious event of streptococcal pharyngitis.</p><p><strong>Conclusion: </strong>Mirikizumab demonstrated significant clinical effectiveness in achieving clinical remission, response, and CSFR in patients with UC.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1864-1872"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Should Colon Cancer Screening Begin? The Impact of Early-Onset Colorectal Cancer and the Reality of an Unscreened Older Population.","authors":"Iris Lansdorp-Vogelaar, Linda Rabeneck","doi":"10.1007/s10620-024-08738-6","DOIUrl":"10.1007/s10620-024-08738-6","url":null,"abstract":"<p><strong>Background: </strong>Recent increases in colorectal cancer (CRC) incidence and mortality under age 50 have led the US to recommend starting screening at age 45 years instead of 50. Several other countries are now also reconsidering the age to start CRC screening.</p><p><strong>Aims: </strong>To aid decision makers in making an informed decision about lowering the starting age of CRC screening in their jurisdictions.</p><p><strong>Methods: </strong>In this article, we present the clinical and modeling evidence for the optimal age to start CRC screening and provide a checklist of considerations for decisions on age to start CRC screening.</p><p><strong>Results: </strong>Two observational studies showed that detection of advanced neoplasia in those aged 45-49 years undergoing colonoscopy was at least as high as in those aged 50-54 years. One Taiwanese study reported a 22% reduction in CRC incidence and a 39% reduction in CRC mortality from FIT screening in those 40-49 years compared to those 50 years and older. Nine modeling studies concluded that lowering the age to start screening to age 45 was cost-effective. However, lowering the start age can have negative spill-off effects, such as increased wait times for diagnostic colonoscopy for symptomatic individuals and decreased screening participation. In an effort to support decision making and prevent negative spill-off, the National Colorectal Cancer Screening Network in Canada proposed a Worksheet to determine the resource impact of earlier screening initiation.</p><p><strong>Conclusions: </strong>Lowering the age to start CRC screening to 45 years likely leads to a reduction in CRC incidence and mortality but requires additional healthcare resources. Policy makers can use the worksheet to assess the expected increase and assess the feasibility within their jurisdictions.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1703-1710"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splitting the Difference: What Is the Best Colonoscopy Prep?","authors":"David P Gerard","doi":"10.1007/s10620-025-09081-0","DOIUrl":"https://doi.org/10.1007/s10620-025-09081-0","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Aberrant Anatomical Configuration of Bile Duct and Pancreatic Duct Diagnosed with ERCP.","authors":"Suyan Qiu, Yang Li, Hailin Jin, Hui Li, Tingsheng Ling","doi":"10.1007/s10620-025-08862-x","DOIUrl":"10.1007/s10620-025-08862-x","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1728-1730"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It's All About the Bubbles: Assessing the Effects of Simethicone on Safety and Efficacy During Colonoscopy.","authors":"Michael A Perrin, Theresa H Nguyen Wenker, Scott A Larson","doi":"10.1007/s10620-025-08938-8","DOIUrl":"10.1007/s10620-025-08938-8","url":null,"abstract":"<p><strong>Background: </strong>Theoretical infection concerns prompted national Department of Veterans Affairs guidance prohibiting simethicone use in colonoscope reservoirs on January 1, 2024.</p><p><strong>Aims: </strong>We sought to determine if reservoir simethicone is associated with post-procedure infection and impact on procedure time, sedation usage, and adenoma detection rate.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all-comers undergoing colonoscopy at Houston's Veterans Affairs hospital during September 1-30, 2023 (reservoir simethicone) and April 1-30, 2024 (aliquots administered on request [channel simethicone]). Primary outcomes were mean withdrawal and cecal intubation times. Secondary outcomes were adenoma detection rate, post-procedure 30-day infection rate, and sedation usage. We adjusted for covariates and used linear regression to determine significant predictors for mean withdrawal and intubation times.</p><p><strong>Results: </strong>Of 446 total colonoscopies, 211 used reservoir simethicone (47.3%) and 235 (52.7%) used channel simethicone. Mean intubation time was 8.3 min [SD ± 6.5] in the reservoir group and 9.9 min [SD ± 8.4] in the channel group (p = 0.03). Mean withdrawal time was 17.4 min [SD ± 10.2] in the reservoir group and 20.9 min [SD ± 11.9] in the channel group (p = < 0.01). Reservoir group procedures required less midazolam (p = 0.01) and fentanyl (p = 0.02). Post-operative infection (n = 1 vs n = 0; p = 0.47) and adenoma detection rate (p = 0.92) differences were not significant.</p><p><strong>Conclusions: </strong>Reservoir simethicone was significantly associated with shorter intubation and withdrawal times and lower sedation usage, even after adjusting for covariates, suggesting increased efficiency with comparable infection risk.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1832-1837"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIF-1α Enhances Intestinal Injury and Inflammation in Severe Acute Pancreatitis Through NLRP3 Inflammasome Activation.","authors":"Tao Gao, Huaisheng Zhang, Yuan Xu, Guosong He, Huicong Ma, Chuanming Zheng, Lei Li, Feng Cheng, Hehe Dou, Fulong Zhang, Heng Zhao, Zhaolei Qiu","doi":"10.1007/s10620-025-08926-y","DOIUrl":"10.1007/s10620-025-08926-y","url":null,"abstract":"<p><strong>Background: </strong>Severe Acute Pancreatitis (SAP) is associated with significant intestinal injury and inflammation. Hypoxia-Inducible Factor-1α (HIF-1α) and NLRP3 inflammasome have been implicated in this process, but their specific roles remain unclear.</p><p><strong>Objective: </strong>This study aims to elucidate the roles of HIF-1α and NLRP3 in the pathogenesis of SAP and their effects on intestinal injury, barrier function, and inflammatory responses.</p><p><strong>Methods: </strong>A SAP rat model was established, and histological changes were assessed via HE staining. Western blot was used to analyze HIF-1α and NLRP3 expression in intestinal mucosa. The effects of HIF-1α modulation were examined using the activator DMOG and inhibitor BAY87-2243. Immunohistochemistry, ELISA, and TUNEL staining were used to evaluate intestinal barrier function, permeability markers, and apoptosis.</p><p><strong>Results: </strong>HIF-1α and NLRP3 expression significantly increased in SAP rats, peaking at 72 h. HIF-1α activation aggravated intestinal injury and barrier dysfunction, decreasing tight junction protein levels and increasing epithelial apoptosis. Enhanced intestinal permeability and elevated pro-inflammatory cytokines were also observed. Furthermore, HIF-1α activation promoted NLRP3 inflammasome assembly, resulting in increased caspase-1 and IL-1β expression.</p><p><strong>Conclusion: </strong>HIF-1α exacerbates intestinal injury and inflammation in SAP, likely through NLRP3 inflammasome activation. Targeting HIF-1α may offer a potential therapeutic approach for SAP-induced damage and inflammation.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1813-1823"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daily Vitamin D3 Versus Stoss Vitamin D3 for Correction of 25OHD Deficiency in Children with Inflammatory Bowel Disease, a Randomised Controlled Trial.","authors":"Jonathan E M O'Donnell, Steven T Leach, Nerissa L Bowcock, Siying Chen, Nitin Gupta, Kevin Jiang, Robert N Lopez, Rachel Messenger, Lily Nahidi, Amanda Shapiro, Andrew S Day, Daniel A Lemberg","doi":"10.1007/s10620-025-08913-3","DOIUrl":"10.1007/s10620-025-08913-3","url":null,"abstract":"<p><strong>Introduction: </strong>Vitamin D deficiency is common in Paediatric Inflammatory Bowel Disease (PIBD) and has been implicated in disease pathogenesis and disease exacerbation. Current guidelines recommend oral vitamin D supplementation when 25OHD levels are below 50 nmol/L. Supplementation comes in two forms: either a daily supplement of a low dose of vitamin D3 (2000 IU) for several months or a single high dose of oral vitamin D3-termed 'stoss' therapy, with no consensus regarding optimum treatment.</p><p><strong>Methods: </strong>A randomised controlled trial was conducted in children with a prior diagnosis of PIBD with 25OHD deficiency (< 50 nmol/L), comparing 2000 IU oral D3 daily to a stoss protocol (oral D3 dosage 400,000 IU for 3-12 years of age or 800,000 IU for > 12 years). Children were followed for 12 months, with biochemistry (25OHD, calcium, magnesium, phosphate, parathyroid hormone, haemoglobin, haematocrit, platelets, albumin), stool markers (calprotectin, S100A12), anthropometrics (weight, height, body mass index) as well as clinical disease indices (Paediatric Crohn's Disease Activity Index, Paediatric Ulcerative Colitis Activity Index) and medication use collected at 3, 6, 9 and 12 months.</p><p><strong>Results: </strong>74 children aged 5-18 years completed the study. Both 2000 IU daily and stoss protocol significantly increased 25OHD from baseline values at 3, 6, 9 and 12 months. One patient randomised to stoss protocol had a 25OHD level of 263 nmol/L with normal serum calcium. There was no difference in biochemical, stool or clinical markers between groups at any time point, nor was there any correlation between 25OHD level and calprotectin or 25OHD level and clinical disease activity scores.</p><p><strong>Conclusion: </strong>Stoss protocol was non-inferior to 2000 IU daily vitamin D3 in raising 25OHD levels at 12 months. There was also no difference between 25OHD levels at 3, 6 and 9 months between groups.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1844-1853"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}